About Me
Have done MCM from Pune university and currently working in support of experience in SQL and Unix.
... Show MoreSkills
Database
Operating System
Others
Portfolio Projects
Company
EDM
Description
Project: EDM (Encounter Data Management) Business Rules Configuration
EDM- is widely used healthcare claim submission system in US. It is used to submit Medicare and Medicaid claims to CMS (Centers of Medicare and Medicaid Services) i.e. to US Government.
Technology Used: EDI, Facets, DMS, QNXT, MS Excel, SQL Server 2008.
Role: Data Analyst
Responsibilities:
Analyze, compile and validate crucial medical data in the form of Medicare and Medicaid claims.
Identify problems in 837 formatted data, and provide solution for the same.
Identify problems in claim processing application like Facets, QNXT.
Writing SQL queries on backend data and discuss issues with development team, if any.
Used DML,DDL,DCL,TCL commands, All Sql Function.
To resolve issues on the claims, consult with respective department like BMS claims, BMS enrollment, Provider maintenance, EDM legacy (Development team).
Resubmit the resolved claims to CMS.
Extracting data from Database Tables as per the requirement & various conditions.
UNIX:-
Performing Weekend maintenance activities as per the instructions.
Space management.
Creating files & directories.
Checking files & directory permissions.
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Mobile
Description
Project: Mobile Operator (Tele Communication)
Roles and Responsibilities
Discuss the queries with customer.
Check application status active/De-active
If applicable then refund the amount to customer
Send the daily and weekly report to the seniors
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MS OfficeTools
INSINQCompany
Highmark
Description
Project: Highmark
Highmark is an insurance company base in U.S.A. it also called as Stellar.
Roles and Responsibilities
Discuss the queries with customer.
Check application status active/De-active
Generate Tickets for back end team
Check application status.
Managing daily and weekly report and send to the seniors
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